Usefulness of Electrocardiographic Frontal QRS-T Angle to Predict Increased Morbidity and Mortality in Patients With Chronic Heart Failure
Usefulness of Electrocardiographic Frontal QRS-T Angle to Predict Increased Morbidity and Mortality in Patients With Chronic Heart Failure
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DOI：
10.1016/j.amjcard.2013.01.294
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发表时间：
2013-05-15
影响因子：
2.8
通讯作者：
Zwas, Donna R.
中科院分区：
文献类型：
--
作者：
Gotsman, Israel;Keren, Andre;Zwas, Donna R.
心力衰竭(HF)死亡的风险很高。心电图空间QRS-T角反映了复极序列方向的变化，并预测了普通人群的死亡。额部QRS-T角很容易测量，但尚未在大型慢性心力衰竭队列中进行评估。我们研究了额叶QRS-T角在预测大量心力衰竭患者临床结局中的意义。根据基线12导联体表心电图的额部QRS和T轴计算QRS-T夹角。这些患者被跟踪观察心脏相关的住院和死亡情况；5038名心力衰竭患者接受了评估。平均随访期为576天，其中51%为男性。随访期内总存活率为83%。在调整了年龄、性别、缺血性心脏病、高血压、心房颤动、体重指数、脉搏、血清血红蛋白、钠、估计肾小球滤过率和尿素水平等显著预测因素后，COX回归分析表明，QRS-T角是男女死亡率增加的增量预测因素。对于女性，QRS-T角为60度的危险比为1.35(95%可信区间为1.04-1.75；p=120度的危险比为1.45(95%可信区间为1.10-1.92，p=130度的危险比为1.53(95%可信区间为1.14-2.06，p=125度的危险比为1.47(95%可信区间为1.20-1.80，P
The risk of death in heart failure (HF) is high. The electrocardiographic spatial QRS-T angle reflects changes in the direction of the repolarization sequence and predicts death in the general population. The frontal QRS-T angle is simple to measure but has not been evaluated in a large chronic HF cohort. We examined the significance of the frontal QRS-T angle in predicting the clinical outcome in a large cohort of patients with HF. The QRS-T angle was calculated from the frontal QRS and T axis of the baseline 12-lead surface electrocardiogram. The patients were followed for cardiac-related hospitalizations and death; 5,038 patients with HF were evaluated. The mean follow-up period was 576 days; 51% were men. Overall survival during the follow-up period was 83%. Cox regression analysis after adjustment for significant predictors, including age, gender, ischemic heart disease, hypertension, atrial fibrillation, body mass index, pulse, serum hemoglobin, sodium, estimated glomerular filtration rate, and urea levels, demonstrated that the QRS-T angle was an incremental predictor of increased mortality in both genders. For women, a QRS-T angle of >= 60 degrees had a hazard ratio of 1.35 (95% confidence interval 1.04 to 1.75; p = 120 degrees had a hazard ratio of 1.45 (95% confidence interval 1.10 to 1.92, p = 130 degrees had a hazard ratio of 1.53 (95% confidence interval 1.14 to 2.06, p = 125 degrees gave a hazard ratio of 1.47 (95% confidence interval 1.20 to 1.80, p